Cuba's health care system has long been the envy of much of Latin
America and the Third World, with the government providing free primary
care, as well as hospital services and dentistry, to 100 percent of the
population. The success of the system is reflected in indicators such as
life expectancy and infant mortality that are comparable to those in many
developed countries.

But the end of aid and preferential trade from the Soviet bloc
following the dismantling of the Soviet Union in 1989 has caused a major
contraction in the economy. At the same time, Cuba's access to foreign
currency has been "severely hindered" by the U.S. trade embargo, according
to the Pan American Health Association (PAHO).

Although health care has continued to be a high government priority,
with overall expenditure increasing 17 percent between 1989 and 1994,
according to PAHO, the lack of foreign currency is reflected in sharp
decreases in health care investment, a growing scarcity of drugs and the
inability of the health care sector to easily obtain disposable medical
supplies and replacement parts for aging, pre-revolution equipment made in
the United States.

These shortages, while not affecting overall public health indicators,
have resulted in increases of treatable conditions such as acute
respiratory infections and intestinal infectious diseases, among others.
Food intake in Cuba has fallen below nutritional requirements in recent
years.

The Cuban government, and many Cubans, blame the shortages and general
decline in the quality of health services on the embargo. While the sale of
most pharmaceuticals and medical supplies are not prohibited under its
terms, U.S. government procedures for selling drugs to Cuba are "difficult,
discouraging and cumbersome," according to an Oxfam America study, and few
companies participate. Many products are not available in other countries;
the cost of those that are available is increased significantly by
long-distance shipping costs.